Provider Demographics
NPI:1386689248
Name:ALBANY MEDICAL COLLEGE
Entity type:Organization
Organization Name:ALBANY MEDICAL COLLEGE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DEAN
Authorized Official - Prefix:DR
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:P
Authorized Official - Last Name:VERDILE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:518-262-6008
Mailing Address - Street 1:1275 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:MENANDS
Mailing Address - State:NY
Mailing Address - Zip Code:12204-2638
Mailing Address - Country:US
Mailing Address - Phone:518-262-9705
Mailing Address - Fax:518-262-9638
Practice Address - Street 1:47 NEW SCOTLAND AVE
Practice Address - Street 2:MC: 57
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12208-3412
Practice Address - Country:US
Practice Address - Phone:518-262-9600
Practice Address - Fax:518-262-9707
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-17
Last Update Date:2020-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Multi-Specialty
No207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Multi-Specialty
No207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Multi-Specialty
No207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Multi-Specialty
No207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
No207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Multi-Specialty
No207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical OncologyGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9766804Medicaid
NY01226920Medicaid
VT1006966Medicaid
NY01520676Medicaid
NYW0V032Medicare ID - Type UnspecifiedDOWNSTATE
NYCC3685Medicare ID - Type UnspecifiedRR
NYW0V031Medicare ID - Type UnspecifiedDOWNSTATE
NY39183AMedicare ID - Type UnspecifiedGROUP NUMBER
NYCA1523Medicare ID - Type UnspecifiedRR
NYCD4772Medicare ID - Type UnspecifiedRR
VT1006966Medicaid
NYC30640Medicare ID - Type UnspecifiedRR
NYCB9202Medicare ID - Type UnspecifiedRR